Risk of pseudomonas is defined as any patient who has documentation of one of the following by the physician/advanced practice nurse/physician assistant (physician/APN/PA):

Bronchiectasis documented as a possible consideration. Bronchiectasis is defined as chronic dilatation of a bronchus or bronchi, with a secondary infection that usually involves the lower portion of the lung. Dilatation may be in an isolated segment or spread throughout the bronchi.

Y (Yes) The patient has risk of pseudomonas as indicated by documentation of one or more of the above conditions.

N (No) The patient has no risk of pseudomonas as indicated by none of the above conditions being documented in the medical record or unable to determine from medical record documentation.

Notes for Abstraction:

Repeated antibiotics and/or chronic systemic corticosteriod can be for any reason. It does not have to be linked to the structural lung disease. Example: Patient is taking chronic steroids for Lupus and they also have COPD.”

For the purposes of this data element, structural lung disease includes:

Chronic Bronchitis

COPD

Emphysema

Interstitial lung disease

Pulmonary Fibrosis

Restrictive lung disease

One time use or one course of antibiotics or systemic corticosteroids is not considered chronic.

Corticosteroids listed as “home meds” or “current meds”, are considered “chronic”, unless there is documentation it is a one time course, or if it is listed as ‘PRN’.

“Repeated antibiotics” are defined as documentation of multiple “rounds” or “courses” of antibiotics.

If there is documentation of chronic ‘steroids’, select “Yes.”

Suggested Data Sources:

Consultation notes

Emergency department record

History and physical

Progress notes

Admitting physician orders

Admitting progress notes

Physician admission note

EXCEPTION: “Home meds” or “current meds” do not require documentation by a physician/APN/PA; other data sources may be used.

Additional Notes:

Guidelines for Abstraction:

Inclusion

Exclusion

Bronchiectasis

Need to evaluate for

Possible

Probable

Questionable

Rule/out bronchiectasis

Pseudomonal Risk:

Pseudomonal risk

Structural lung disease with multiple rounds of antibiotics

Structural lung disease with chronic systemic corticosteroid use

Structural lung disease with long-term systemic corticosteroid use

Refer to Appendix C, Table 2.15 for a comprehensive list of Systemic Corticosteroids.

Bronchiectasis

Doubt bronchiectasis

Respiratory problems without mention of bronchiectasis

Pseudomonal Risk

Structural lung disease with no documentation of a history of repeated antibiotic use or chronic systemic corticosteroid use.